HAART effectively controls HIV replication in HIV-positive individuals, but chronic immune activation persists, leading to increased virus replication, T cell depletion, and exhaustion, necessitating lifelong HAART to prevent disease progression. This study explores the potential of supplementing HAART with Artemisia annua and Moringa oleifera leaf powders as adjuvants to restore immune function and control viral replication in PLWH. A nested cohort study was conducted with 31 PLWH on HAART randomized to the control group (n = 15) and the intervention group (n = 16) that supplemented HAART with A. annua and M. oleifera leaf powder. Peripheral blood mononuclear cells (PBMCs) were obtained from the study participants to measure the expression of the activation markers (IFN-?, IL-2, IL-10, and HLA-DR), inhibitory and degranulation receptors (PD-1 and CD107a respectively) expressed by CD4+ and CD8+ T cells using flow cytometry at baseline and 12 months. Viral load was also measured using the quantitative polymerase chain reaction (qPCR). Compared to the controls on HAART only, patients in the intervention group had increased frequencies of CD4+ T cells (p = 0.003), decreased viral load (p = 0.046), and decreased production of IL-10 (p = 0.010). We also observed a non-significant trend showing a decrease in the degranulation maker (CD107a), exhaustion maker (PD-1), and activation markers (HLA-DR, IL-2, and IFN-?) produced by CD4+ and CD8+ T cells. Our study revealed that HAART supplementation with M. oleifera and A. annua causes faster viral load suppression and elevation of CD4+ T cells with suppressed IL-10 expression. Co-supplementation also increases the expression of CD4+ T cells associated with the suppression of PD-1 and elevation of IL-2 expression, suggesting virological and immunological recovery among patients on HAART.

Keywords: Artemisia annua, Moringa oleifera, PLWH, T cells, Viral load, HAART, Exhaustion.